Although a federal judge ruled last week that Molina Healthcare Inc. is owed more than $52 million under an Affordable Care Act program meant to promote insurer participation in the ACA public exchange system, the California-based insurer may not see the money anytime soon.
With one claim still pending, the case is among more than two dozen winding their way through the U.S. Court of Federal Claims, as the health care industry faces increasing uncertainty: Just two days before Judge Thomas Wheeler issued the ruling in Washington, last week, Molina announced that it will pull out of the exchange programs in Utah and Wisconsin by the end of the year. The company reported losses of $230 million for the second quarter.
Wheeler on Aug. 4 granted partial summary judgment in favor of Molina, ruling that the federal courts have the authority to get the cash for the risk corridor program payments from the federal Judgment Fund. The fund makes an indefinite, unlimited appropriation available to pay court judgments entered against the United States.
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The Wheeler decision is the second win for insurers that has emerged from in a wave of litigation related to the risk corridors program.
Drafters of the ACA established the program in an effort to ease health insurers’ fear of providing coverage for previously uninsured Americans.